High-Intensity Lipid Lowering May Aid Very Elderly After ACS

Among patients hospitalized for acute coronary syndrome (ACS), the greatest benefit from simvastatin-ezetimibe compared with simvastatin alone to lower lipid levels was observed in those 75 years of age or older, according to a study published online in JAMA Cardiology.

Richard G. Bach, M.D., from the Washington University School of Medicine in St. Louis, and colleagues assessed the effect of higher-intensity treatment to lower lipid levels (combination ezetimibe and simvastatin) to simvastatin monotherapy among patients with stabilized ACS during a median six years of follow-up. The prespecified secondary analysis compared outcomes and risks according to age based on data from the randomized trial, which enrolled 18,144 patients (75.7 percent men), of whom 28.5 percent were 65 to 74 years old and 15.4 percent were ≥75 years.

The researchers found that treatment with simvastatin-ezetimibe resulted in lower rates of the primary end point (composite of death due to cardiovascular disease, myocardial infarction, stroke, unstable angina requiring hospitalization, and coronary revascularization after 30 days) versus simvastatin alone. This trend existed for all age groups, but the greatest absolute risk reduction was seen in the oldest patients (0.9 percent for patients <65 years: hazard ratio [HR], 0.97, 95 percent confidence interval [CI], 0.90 to 1.05; 0.8 percent for patients 65 to 74 years: HR, 0.96, 95 percent CI, 0.87 to 1.06; 8.7 percent for patients ≥75 years: HR, 0.80, 95 percent CI, 0.70 to 0.90; P = 0.02 for interaction). There were no differences in the rate of adverse events with combined therapy versus monotherapy among younger or older patients.

"These results may have implications for guideline recommendations regarding lowering of lipid levels in the elderly," the authors write.

This study was supported by Merck; several authors reported receiving grants and fees from pharmaceutical companies.

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